A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study.

BACKGROUND: Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype. METHODS: A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype. RESULTS: The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001). CONCLUSIONS: These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.

Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients.

BACKGROUND & AIMS: The purpose of this study was to comprehend and describe the views, experiences and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition. The objective was to gather empirical evidence to improve the delivery of Home Enteral Nutrition for old patients taking into account the caregivers' support needs. METHODS: A qualitative methodology with focus groups as data collection method was used to collect the testimonies of 30 informal and formal caregivers of older patients treated with Home Enteral Nutrition by the Clinical Nutrition Service of INRCA (Ancona) during 2014. Quantitative methodology was used to collect socio-demographic data. Partially modified Silver's "Home Enteral Nutrition Caregiver Task Checklist" was used to identify training needs. The constant comparison method was used to code and categorize data and to develop themes of focus groups. Simple descriptive statistics were used to summarize questionnaires. RESULTS: Five main themes were identified from focus groups: acceptance of the therapy, skill acquisition process, need for psychological and practical support at home from healthcare professionals, lifestyle adaptation, affirmation of life and family. All caregivers testified the initial fear and refusal to manage the nutrition pump and the therapy. They expressed the need to be trained gradually, starting during a patient's hospitalization, and continuing in the community. With reference to their overall QoL, it emerged that informal caregivers suffered mostly from the reduction of their free time while formal caregivers suffered social isolation and psychological burden. For both groups the monthly home visit was the most important element of the HEN service. Informal caregivers highlighted the importance of having their loved ones at home. Unsatisfied training needs were identified by the modified Silver's "Home Enteral Nutrition Caregiver Task Checklist". CONCLUSIONS: This qualitative study underlined the challenges and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition, which should be considered when defining clinical protocols and supporting caregivers.

Force-displacement relationship during anteroposterior mobilization of the ankle joint.

OBJECTIVE: The purpose of this study was to determinate the correlation between force and displacement during passive anteroposterior mobilization of the talus and the effect of this treatment technique on ankle dorsiflexion range of motion (ROM). METHODS: This is an exploratory, methodological study. Maitland grades III and IV mobilization were applied on the right ankle of 25 healthy subjects (mean age +/- standard deviation, 25.08 +/- 3.01 years) by 2 randomized raters (A and B). Applied forces were measured using a small force plate and displayed for the rater on a computer monitor. Linear displacement of the ankle joint was quantified by a motion analysis system. Synchronization of these 2 systems was obtained by software. Dorsiflexion active ROM, before and after mobilization, was assessed using a biplane goniometer. Statistical analysis was performed using the Pearson correlation coefficient for force and displacement variables and the paired t test to compare dorsiflexion ROM mean values. RESULTS: A fair positive correlation was found between force range and displacement (r = 0.370; P = .049, 1-tailed), and a fair negative correlation was found between minimum forces and displacement (r = 0.404; P = .035, 1-tailed), only for rater A data. Significant increase in dorsiflexion was found in the right ankle (P = .035), comparing ROM before and after mobilization, which did not occur in the left ankle. CONCLUSIONS: These data do not support a linear force-displacement relationship during Maitland grades III and IV passive joint mobilization, although they confirmed an increase in ankle dorsiflexion ROM immediately after joint mobilization. The use of visual feedback may increase interrater reliability of forces applied during ankle joint mobilization.

Study of the force applied during anteroposterior articular mobilization of the talus and its effect on the dorsiflexion range of motion.

OBJECTIVE: The aim of this study was to investigate the behavior of the force applied during the Maitland grade III anteroposterior joint mobilization of the talus and its effect on dorsiflexion range of motion (ROM). METHODS: Two examiners performed measurements of dorsiflexion ROM on both ankles of healthy volunteers using a universal goniometer. The anteroposterior talus mobilization was first applied by examiner A for 30 seconds. Examiner B then repeated the same procedure. A platform was placed under the volunteer's leg to register the forces obtained during mobilization. After the procedure, examiner A assessed the ankle dorsiflexion. RESULTS: The results showed consistency regarding maximal forces applied throughout the 30 seconds of mobilization as well as low consistency upon the minimal forces. A significant increase in dorsiflexion ROM of the ankle was found immediately after joint mobilization. CONCLUSIONS: The results of the present study have shown consistent maximal forces applied by one examiner and inconsistent minimal forces during an ankle mobilization in healthy volunteers when the same examiner was compared. Moreover, the applied force was able to increase dorsiflexion ROM after the Maitland grade III anteroposterior mobilization of the talus.